welcome to the bring intimacy back show where is real on this show we believe that intimately connecting with yourself your significant other children family business Network community and your higher power can elevate your life to work towards a positive future that's we explore intimate topic inspiring life stories spiritually and insightful tips on strengthening relationship this show is hosted by dr. April a Florida licensed mental health counselor relationship and intimacy therapist board certified telemental health counselor National Certified counselor and a certified sex therapist she is the owner of vacation counseling and Cape Coral therapist and the creator of the internet connections newsletter for more information about dr. April services and the bring intimacy back show please visit bring intimacy back. Com check out tasks shows on Apple ID

Spotify YouTube or wherever you listen to your podcast now let's get this episode of the bring intimacy back show started because we share with you the secret power to intimacy to create a life you love or love the life you create now here's your host dr. April well today and we talked about a lot and dealing with intimacy for today we're going to talk about is what if you're struggling and being intimate so it's a topic is so you want to know why I can't be intimate with some people they have pain they have dysfunction and so what I got today is a very special young lady of bilingual family nurse practitioner of pelvic health support actually she does pelvic floor 101 welcome Kathie case how are you doing I'm doing well. Your April how are you

doing good Yeah Yeah Yeahs self Kathy's here today to talk and to educate not only you but to also to educate me about health account and pelvic health is kind of really talked about with doctors with couples and stuff but it really does impact everyone in a relationship so as a pelvic floor specialist and she works with men women transgender extension on to torment patient experiencing chronic pelvic pain and other Floor Covering floor dysfunction I'm her practice is evidence-based care and she includes medical knowledge and her biochemical approach to help us understand how we can be intimate or what you how we can you send V without self in the symptoms of pelvic floor and she's that does not only because this is her passion but she's also had experience

Survivor welcome thank you so much so tell me how you been doing the last few months with Toby and your business and all that kind of stuff so hanging in there and I will say that we did shut down our offices for in-person visits for March April and May our physical space is located in Boston and so that actually opened up the possibility of virtual visits which I never would have thought would work I'm a pelvic floor therapist and

total silver lining for me that people that are ready to dive into the virtual realm there's so many things that we can do in the virtual realm that are so beneficial to Bringing balance to not only the internal muscles of the pelvic floor but the whole person my practices holistic and whatever pelvic floor dysfunction is going on we need to look at the whole person so a decating I'm out audience cuz people are make me say what is the pelvic floor

and I would love to share that I've been a nurse practitioner for 10 years and run a women's health program and running a women's health program for 4 years

before I knew what the pelvic floor was so no shame in not knowing what the pelvic floor is I was doing and I still do all sorts of GYN procedures and never think it taking a step back to think about what's going on with the muscles with the tissue inside so no shame at all if no one else at their pelvic floor is not so much so is in the very center of the body the whole pelvic girdle and we look at the pelvic girdle first that's the center of the body do if you think about the your pubic bone and then you think about your sacrum you have muscles inside that run from the pubic bone like a sling all the way back to the sacrum if you think about your hips is

put your hands right around your hips those those are the sides of your pelvic girdle and you have muscles that also run side to side and this is a group of muscles that should have just enough down to be able to keep us continent of both urine and stool that means that you know you shouldn't leak urine when you sneeze or cough or jump it should also keep us continent of stool and four women those muscles should also allow us to keep all of the organs up and inside so not normal to have one of the organs inside your bladder your uterus or even the rectum starting to pop out that said that you can see them on the outside so these muscles this connective tissue

tendons ligaments nerves they all need to work together to maintain that perfect balance

for Optimal Health

incel with an another talking about women with men

with men so if you think about the internal landscape of the pelvic cavity right and you think about the pubic bone the sacrum and the hips on the sides those are the same for everybody so basically the muscles are more or less the same you're talkin about different organs when you're talkin about a male pelvic floor that we have a prostate and it with a female pelvic floor you know you'd have the bladder

uterus so if you tore to take the organs out the muscles are connective tissue or more or less the same for specialist what exactly do you guys do and then I'm also just curious how you even got into the field so what we do is we look at the people sitting standing lying down and we look to see front-to-back what it looks like if you think about like how much of an arch do you have in your low back if you're somebody that has a big arch in your lower back probably means you're tipping your pelvis forward all the time like maybe I'm sitting and standing so if you're tipping your pelvis forward with the bones externally what does that mean that the internal muscles are doing most likely they're starting to work because they want to pull you back into balance between the front in the back there were looking a lot at that we're

still looking if you think about your hip bones that are on the sides of your pelvis you think of them like wheels and they rotate they rotate forward and they rotate back and so we're looking at is this person walking around with one of those hip being pulled perhaps more forward or one of them pulled perhaps back and that all affects the functioning of the internal muscles also we're looking at when you're thinking about those headphones your hip bones not only do they rotate they move up and down so you're looking to somebody just stand and sit with one of those hip bones always listed up if that's the case that impacts the internal muscles of the pelvic floor so once we do a very thorough external examination and this is why all of this work so well virtually all the stuff is stolen

then if the patient is comfortable and with the patient's permission we take a glove lubricated finger and we gently for women's red the labia apart and first look at you need to look external you need to look at the Volvo you need to look at the labia you need to see like what is is the tissue hydrated are there any areas of redness or irritation Use Jelly spread the labia part you insert a gloves lubricated finger and then these are muscles like anywhere else it's just we don't think about them because they're inside and also because they're associated with sexual function so right there people just do not think about them

so then we do a very detailed exam where were assessing and if if you were to put a finger inside of your own vagina and right now I'm talking about people that were born with female anatomy And if you were to put your index finger in and just go up a little bit that's your bladder right a lifetime people don't know where their bladder is so very powerful first thing what we do with an internal exam as we learn the internal landscape so if you put a finger in and you go up very superficially like maybe to the first knuckle on your index finger you're going to hit your bladder if you've turn the finger around and go down you're going to hit your tailbone that right

so hugely important to know where these things are people think about their tailbone from the outside but guess what there's an internal component to your tailbone right and then if you got your bladder at the top and if you think about a clock you can think about your bladder being at 12 your tailbone being down at 6 and then you just go around the whole clock and you're assessing the muscle the tissue are there any areas that feel hot hard or Tender or just to feel very restricted that's important information to have till after we've done a thorough exam then I will ask people to inhale because when we inhale the pelvic floor muscles hopefully something a little bit maybe they do maybe they won't I just want to know and then I asked people to Exhale and try to lift up the pelvic floor muscles or engage

I really don't like to use the word squeeze I prefer engage and I want to see what is the the strength of your pelvic floor do you have the ability to let the muscles relax and do you have the ability to let the muscles contract and then with all of that information

we devised the appropriate treatment plan for that patient has a I'm a nurse to let you go and I think about nursing they think about maybe going into the hospital and helping people and all that and this here

so again having run a women's health program for 4 years

I at 4 years into my career I was diagnosed with breast cancer and after a lot of chemotherapy a lot of surgery and I'm so fortunate that the cancer is gone but after that whole process and because I was positive for one of them I had there's a higher risk that I would then have develop ovarian cancer

so I decided to have my ovaries taken out so that put me into surgical menopause so all of a sudden like after probably I don't know you're in and out of treatment that I was in surgical menopause and I was like oh my God it's so it hurts to have sex and I don't know how the hell I don't know how to help myself me who runs the women's health program I don't know what to do

okay so I went to my own nurse practitioner who works at a gynecological oncologist oncology office which is just a fancy word for the women's cancer women's health cancer practice and exam and she said oh my goodness you need to go to pelvic floor therapy and I said what is that

she gave me a list of people and she said I think you should go to these particular people and I did and I learned so much and it was so incredibly helpful to my own healing Journey you know recovering from cancer it gave me my Sexual Health back and I thought oh my God like how can I learn how to do this I need to people need to know I'm a nurse practitioner and I didn't know people need to know right and then when I first tried to find a provider to help me before I went to my nurse practitioner there's a very prominent cancer hospital in Boston and I called them and they said that they have a survivorship program I said great do you have a gynecologist and they said yes she does one session

for 4 hours once a month and there's a six-month waitlist to see her and so I just started to think

about

how hard it is right be there hard things to talk about like I get it like nobody want really wants to call a pelvic floor therapist nobody it's hard right and I know it because I didn't want to do it and then I had to put all of these different pieces together in order to learn and in order to help myself and I thought I can be the perfect accompaniment for someone trying to Blake let me help to put the pieces together to just make it easier for you

yeah okay we're going to take a short break when we come back anyone he's out there listening and you're thinking well I'm having trouble with intimacy maybe I'm in pain maybe send positions maybe cuz I'm just feeling uncomfortable or even like she said even not even being able to hold your bladder all the time you know and that it interferes and an affect intimacy was when we come back he's going to let us know everything that's some of the stuff that she learned her text you don't know we don't know everything's got to go see here but I'll see what we can do and what you can do to help yourself if you're experiencing troubling times and intimacy with pelvic pain will be back in a few minutes

during this difficult time that we are all facing

many people are in need of someone to talk to

when option is speaking to a therapist to express your anxieties if you're feeling isolated or just need someone that will listen and help you with coping skills to get through

dr. April Brown is now accepting new clients and is working with her existing clients through distance video counseling the services are through a secure online HIPAA based practice management platform called Simple practice this technology can provide a secure two-way interactive video counseling session over the internet

for more information about video counseling please email dr. April Brown at info at dr. April Brown

dot-com or you may call 239-565-6921 thank you and remember we are all in this together

welcome back to bring in intimacy show where is Missy is real today we're talking about how the floor and pelvic pain so I'm Kathy and Rick have a specialist here Kathy case family nurse practitioner so Kathy if there's a woman out there or starts with the female at the moment and they're like

you know having paint

you know every time we have intercourse for some reason I'm having pain

what would you suggest in the sense of his pelvic floor and maybe getting some help or resources absolutely so first question is there any foreplay happening before they are we talking about I guess I would forsake what I need to be clear on the pain is it pain with foreplay is it pain with penetration of penis sex toy anything like that so just getting clear on what it is and then clear so you can think about foreplay like the warm-up you wouldn't go and run

you wouldn't go and run 5 miles without stretching before you went for your run and so people don't think about especially women don't think about the do I need to warm up those muscles to get ready to then be able to put something inside or with foreplay with oral stimulation or stimulation with a finger or fingers or even a vibrator anything like that when you stimulate the tissue you're increasing the blood flow that's going to help to open everything up it's going to increase the amount of oxygen in the circulation that is all very good preparation for having something then enter in find of the vagina and foreplay is important with or without an orgasm because you're still getting so much of that benefit from

getting that tissue ready next question for the person once we identify when the pain is happening are you using lubrication and what are you using and are you putting enough lubrication for talking in terms of heteronormative intercourse right now like are you literally putting enough lubrication on his penis and you'd be surprised at the number of people women who don't put lubrication inside of them and some people would say something must be wrong with me if I have to put lubrication totally I hear that all the time and so I feel like one of the most important things I can do is say there's absolutely nothing wrong with you nothing at all some people produce more than others even people that do produce a lot of lubrication I still

find oftentimes will benefit from lubrication and then you have to be very careful about exactly what lubrication you're going to use wasn't a lot of just had bad ingredients out there for people so you want to look for his fuse ingredients as possible you don't want anything warming cooling no smell no glycerin is no parabens always do you know you can try water-based lubricant first you could consider silicone write a silicone-based lubricant or even an olive oil-based or oil-based lubricant ingredients that people think we're all that may make things better or right because you don't want to irritate

the vaginal pH right like your vagina is this miraculous self cleaning oven the balance the pH of your vagina is just right and literally it really is like a self cleaning oven yeah that's not kind of what the media show solutely not absolutely not like nobody should do know they need to all be just thrown out burned like out there is nothing wrong your vagina just as it is is like I said it's a miraculous self cleaning oven so we don't want to introduce anything with a lubricant that could be potentially disruptive to that

play 80s and 90s music was very popular and again like you said April it's this idea that you know the vagina is dirty and it needs to be cleaned and that is not true it is like I said miraculous self cleaning oven

which is a great thing to do and a great thing to even teach your young ladies near your kids and all that kind of stuff solutely Adam solutely so once you have to look for cat what else has happened in the sense of I know you said for Place really important I think also you want to ask people about positioning right and sometimes there are changes that can be made to the positioning that might help you know maybe popping up glutes on a pillow sometimes can be helpful sideline can be helpful just experimenting with different positions and these are all things that I would want someone to try to you know came and said I'm having pain with intercourse

yeah I never even heard that some people say we're not even out from the research that they feel like something is wrong with them if they can't have an orgasm with their husband such additional Manor oh totally and I believe the research is something like I think 75 or 80% of women do not have an orgasm with penetrative intercourse and you said yeah and like you said with the time different position because all our vaginas do not look the same

no

so these are all things that you can think about in this is for somebody who is having sex and it's hurting this is not for somebody who you know has never been able to put a tampon and can't put anything inside and has not had sex that's a very different discussion these are all things I would think about prior to maybe coming to see someone like if you're waiting you know that if you're on a waitlist to see someone like me maybe these are things you could try I also think you have to

and this is hard and this is really hard right now during covid-19

your state of mind right like you have to be present yourself and also with the person that you're with right because when your mind you I'm sure could speak to this very thoughtfully when your mind is racing and racing and racing it's very hard to slow that down sometimes to be present in your own body and then to feel what it feels like to be connected to someone. Those are all hard when you're under stress and when you're under stress and your mind is racing the reaction of physical reaction in the body can often be to tighten and it's not just in your back and your shoulders guess what it's your pelvic floor 2

like and look just like you said if your stress or if you're not present and something is happening to your body your body is going to tense up and it's not so relax and it may not even could you spell fluids because that's all

I know you mentioned earlier vibrators and some people yeah yeah that not help so it depends on the patient and their comfort level with you do first of all is someone comfortable using a vibrator and then also exploring a little bit if they're not kind of teasing that out a little bit and why is that so vibrators can be great I think again there are a lot of vibrators out there that are made from less-than-ideal Material like you want you need to treat yourself right like you need a nice medical grade silicone soft nice beautifully manufactured vibrator you are worth it right and then you have to figure out if someone going to be more comfortable with just clitoral stimulation external stimulation is there a way that I

a lot of patients that have vibrators that they're only using outside the sometimes we think about always there a way that we could maybe think about using that inside and again the whole idea behind the vibrator is the stimulation of the tissue the tissue gets stimulated it gets a little bit more relaxed a little bit more open so even if I do some people like pain and they said I didn't have came with this partner do dilators

kitten cannot really help in the sense of if you're starting to have pain too just to see

yeah we're absolutely so what we do and again fees are for patients that are already sexually active with a partner

if it's someone who hasn't ever been sexually active it's going to be a little bit different but what we do is we bring out the whole set of vaginal dilators they're sized 1 through 8 we take a look we open the open them up we look together and then we have the women in my office at we say how big is your partner and then like when he is fully erect and then we find that died later and that is our goal but that is by no means what we start with again because of what is a dilator doing it's stretching it's stretching right and so often people just think about

dilation is like what happens to the cervix when you have a baby but vaginal dilators are fantastic for stretching the muscle and the tissue right and so if you're consistent with a dilator routine if that's something that's appropriate for you you will absolutely the results are there also exercises to help us so anytime that you or we can find a physical shape

that puts your body in into that shape that will allow your pelvic floor muscles to relax then yes and that's how you know so think about like if you lie down flat on the floor with your knees bent and your feet are have with distance apart your sacrum the whole back of your pelvic girdle is supported your shoulder blades are on the ground they're supported your pelvic girdle and your shoulder girdle their girdles there stabilizers for you if you just open out your feet a little bit wider than hip with distance apart put the needs together

while I your pelvic floor starts to soften and I will save the Hallmark of pelvic floor therapy is diaphragmatic breathing

can you play with that is I absolutely can so if you were to put your hands like right where your ribs come together in the front of the chest right there's a divot where they write come together right in that whole soft area that's your diaphragm that's your muscle for breathing that works in concert with your pelvic floor so every time you inhale that pelvic floor stop in a little bit every time you inhale the pelvic floor can you engage and I think what we're seeing

just manifested hugely right now with all of the stress is no one can take a break no one can breathe everyone's breathing with her with their from their upper chest and from their neck and with their shoulders so then you've essentially shut down the diaphragm and when your diaphragm to shut down that shuts down your pelvic floor so if you're walking around with a tight pelvic floor it's never going to let go because you're not taking the rest of the way that we are designed to take a breath

do I know we talked a lot about the female body you know how does this impact on the mail

excellent question so when there is pelvic floor dysfunction for men we see scrotal pain testicular pain premature ejaculation difficulty getting an erection maintaining an erection lot of urinary symptoms like urinary frequency urinary burning and there is never an infection and they got like your analysis after urinalysis and never an infection and they go to the urologist in nine times out of ten they're like you have you know you need antibiotics and then there's never any change and then hopefully they find out about pelvic floor therapy and then they begin to learn Arabic floor dysfunction.

I didn't know that we do or that we don't eat or any other insurance so posture has a ton to do with it right and so that's number one right there when you sit and when you stand you know are you that is the hugely important for keeping that pelvic girdle and balance and I think you asked about eating right so also an excellent question and like anything else I believe we have to think about food as medicine if I you know I write prescriptions all the time for people I wish I could write a prescription for a healthy food. That would probably be the prescription I would write the most do anything you know if you're eating a diet that's got a lot of processed food a lot of sugar anything that's going to trigger that inflammation Cascade and increase the inflamed

free response in the body absolutely that will affect your pelvic floor muscles it affects everywhere else do it your is going to affect those muscles they just happen to be inside you have patience that's that further embarrass to come back and have not even told their partner that they're in pain absolutely yes all the time all the time and I feel

it's so important to help particularly women to be able to advocate for themselves to say this is what makes me feel good right until part of this whole part of also I feel like a part of pelvic floor therapy is also really helping women to reclaim their sexuality and what makes them feel good and what doesn't make them feel good and that's where all a work-in-process listening is the tip pain with sex and she found out that she had fibroids after ending up with having a hysterectomy and she had sex with all different and wonderful for her but because it was no pain she wasn't actually able to have an orgasm and she's happy for not being in pain but she can

happy orgasm with with having sex and what is the question the question is basically guess she had an hysterectomy and she had because you had five whatever and yes and so that's a pain but she isn't still yet able to have an orgasm so what I would say we should think about is the use of a vibrator and maybe you know after an exam like maybe they use of dilators to really assess the tone of the pelvic floor and she may not be having pain with sex anymore which is wonderful but I do wonder if there isn't some underlying what we call hypertonicity or tension in the pelvic floor that is getting in the way

of being able to have an orgasm

okay so when you talked about the examination and you use it's like a clock yeah yes yes yes so if you find the area of the clock Tinder

what you guys do with that

the one you do ya know it's a great question so what we do we use the Release Technique that's called myofascial release mile Muscle fascia connective tissue so what we do is we identify the restriction and then we go in with very gentle pressure and it's really a symbiotic relationship because we are Jet Li going in if you will re-educating that tissue like you don't have to be that tight and so there has to be where the symbiosis happens is that the person on the table has to be able to let us in a little bit and through extended gentle pressure we are able to think in

through level layers of tissue connective tissue faccia deep into the muscle and you just have to wait you have to listen with your hands

very deeply and you have to wait and it's through that gentle sustained pressure and time that you can often maybe not right away maybe not the first few times during sessions you can get that restriction to release

okay so it's kind of like you saying like them

first simple terms you have a bruised muscle bruise what you guys do is is gently gently massage it

check if you have you know you can't roll your internal muscles with a foam roller right but if you're like rolling out maybe that's a better example like people have those muscles that run down the sides of the side right those get super tight so that's an area that people will often foam roll right and then as you're running back and forth you identify a spot that it's like really tight and you wait right like you kind of weight you let the weight of your body sink in to use to let that tension dissipate and that's what we do with the myofascial release work is we let through gentle very gentle but yet targeted work we allow for the muscle and the tissue to release

can you do that after you say you have online services so excellent question and what I was going to say is that we can teach patients to create that similar sensation by using a pelvic wand

okay something that is prescribed or is it something you can buy off you could totally buy it off of Amazon I would say I wouldn't recommend buying it off of Amazon because again just like the lubricants and also just like the dilators there's a lot of stuff out there that is not good and if you're going to do pelvic floor therapy you're going to get a vibrator maybe get a dilator maybe get a wand you deserve the best one you could find and we have vetted them for you so you don't have to worry about it if you go on my website I put the vibrators the dilators and the ones that you should be looking at you don't go down the rabbit hole it's not going to do you any good so then in this virtual space

I talk people through how they're going to use the wand how they can identify those tender spots and then what they're going to do to release it okay biking is the perfect spot for us to take a short commercial and for you to let us know all the services you provide and even the resources and I'll take it away Kathy okay so this is Kathy Kate's you can find me at pelvic Health support.com 617-651-1436 I never call myself and we offer

all whole body myofascial release care using a biomechanical approaches well with a focus on the pelvic floor for men with transgender patients and nonconforming patients when you visit the website you'll find evidence based resources from my wonderful colleagues where my physical office space at Wellness Integrative Health is located you'll find evidence based articles to read for resources don't go down the rabbit hole you'll find links for the best vaginal and rectal dilators we've been able to find the best pelvic wands we've been able to find an examples of a water-based lubricant

oil based and silicone-based and you'll also be able to see the full offering of services that we offer not only in office but virtually as well

hi thank you so much and you can definitely find her on Instagram and pelvic floor in PS2 thank you Hunter April talked mostly about male and female relationships but also you what I'm assuming you also work with a blighted by the relationship but also with transgenders who are transforming into another aspect yes yes in helping them with Jess

renew body parts and stuff you also clean absolutely right really really helpful for people born with a vagina but now they have one which was kind of talking about some chips and what is some tips for whenever why let's stop with the partner so what are some tips for partners who may know that their wife or girlfriend or lover is experiencing pain

talk about it be open about it and create a space where you don't have to feel shame around it advocate for yourself and a lot of listening on both sides number 1

what are the tips for the people who are experiencing the difficulties

to name it and then to figure out where you can go to get help and once we name it and also once you realize that you can get help it starts to become you normalize it right we have to normalize this for people a lot of people suffer with

it might not be a lot of pain right A lot of people will say it doesn't hurt that much but it always hurts a little bit when he goes in will let you know when I'm ready to say no like that we do it doesn't have to be like that so naming it being honest about it knowing where to find your resources so that we can normalize it for people and it becomes something that's part of the conversation and not just the only time that people talk about their pelvic floor is postpartum that's it

and I'm so happy you just said number one is to name it because some people think the pain will go away there's something wrong with me and I'm here to say there's absolutely nothing wrong with you what I always say to people is let's talk about all the good things that your pelvic floor has done for you up until I don't know my 35 year old patient right leg for 34 year was like wow your continent all your organs are up where they're supposed to be you had a baby like wow like let's celebrate all the good that your pelvic floor when you didn't even think about it right like that's the thing you never thought about you don't start thinking about it until there's a symptom like perhaps maybe now you have pain right will let's let's reframe it and look at what your pelvic floor has done for you when you didn't know anything about it so magic what your pelvic floor can do if you actually start to learn about it

you also help them just thinking that I've heard we're partner I said to his wife or whatever that after the baby vagina feels different total and the main reason right but the main reason the vagina feels different is the someone is breastfeeding their estrogen levels plummet and we need estrogen to buff up the walls of the vagina and make it plump and juicy and without that it's almost like the vagina looks like a woman who's in menopause

so I spend a lot of time and again you'll find this on my website as well postpartum moisturizing it's a different than lubricating for intercourse it's a totally different thing and women need to be thinking about this from the get-go like as soon as I baby comes out like before I tell people get all the order what you need in your overnight bag because that's probably more important than whatever else you have in your overnight bag is your Volvo vaginal moisturizing routine postpartum so your suggestion is to as soon as that baby comes out on your back home

John Cena like once the bleeding has stopped like dreaming that there's no infection or you know any of that stuff once you're medically cleared you have to start it's like you're in Florida I'm in Boston the Boston Winters are so cold and if you don't put your facial moisturizer on in the winter your whole skin is dry and cracked and it hurts right people don't think about their vulva in their vagina in that way but I can tell you that what is specially postpartum especially menopause once you start moisturizing your vulva and your vagina is life-changing how often moisturize their totally so

I love that for people to moisturize the vulva if that's appropriate everyday like I don't get out of shower noise right and then an internal it depends on what you're using if you're going to use the vaginal estrogen it depends maybe once or twice a week but again it depends on the particular patient but there are a lot of things that we can use that aren't estrogen I'm so for example there's a really nice higher lonic acid based vaginal suppository many people will know higher lonic acid because it's what's in face serums it's what's a face creams it's a pumper upper of the skin of the face it can do the same thing for the vagina right so you know we'll start with maybe three times a week and we see how it goes we also use vitamin E suppositories for vaginal moisture super hydrating vitamin E and you just it's kind of trial and error and you have to see what works for that for

killer patient lights up with y'all and menopause there's also a lot of natural things you can do first is taking a lot of hormones sir I mean and I will say about estrogen a lot of people are you know because I am a nurse practitioner because I prescribe because I work very closely with a lot of oncologist and gynecologist lot of people are afraid of estrogen and I don't think you need to be I think you need to have that conversation with your provider okay cuz it's a tiny amount it gets absorbed systemically and I think a lot of us in the medical world are like who estrogen bad and I think we shouldn't discount its use and I think there are many other things to try before like the vitamin D like the higher lonic acid all those kinds of things it's

but it's an and okay yeah yeah we covered the hole in the sense of dealing with and how important it is and just think like when you drink a lot of water and you're eating well your tissue your muscles are well hydrated you move better it's the same thing right with the internal muscles if you're a moisturizing appropriately eating a healthy diet those internal muscles are going to function better to write so I should just said again. Healthy diet really huge and that kind of stuff and it's one of the things you've also mentioned earlier was it's really important for females to explore

absolutely and we have to figure out what makes us feel good and then we once we figure that out he needs to advocate for ourselves with our partner to say this is what makes me feel good can you help me with this I'm connected to you can you help me to make me feel good I have had listeners are people that I know that have been a thief and look at their own body that's why we have mirrors in the office and even for virtual visits when I send the zoom invitation I please have a mirror

okay like cuz it's important to know your body to see it

100% And it's beautiful whatever whatever body you have it is beautiful because it's yours exactly when you know more about it

absolutely yes yes so you do online visits and visiting person okay and you see people outside of Boston yes awesome oh oh awesome okay sometimes cultural thing where women are just sometimes afraid to talk about their yes

in my experience taking care of a lot of Latina women it's just forget it like this very taboo but that that's on my particular experience and I don't mean to make a generalization just in my own 10 years of caring for Latina women you know when you say people have no idea what makes them feel good they've never been asked it's never been part of the conversation so part of my life's work is to help

it's Riley this is something that may be at Mom's that we should even be talking to our daughters about

absolutely like what does it mean to advocate for yourself and ask for what makes you feel good there two people in a relationship it's not just about pleasing someone else it's about this creating is intimate intimacy together in which you are both feeling good so on your website you also have a good book for people wanting to understand more about this pelvic Health yes absolutely there to that I love Emily nagoski come as you are I'm sure that that's on your bookshelf I think that's a wonderful one and I also really like her book about burnout with her twin sister I just came across town and thought it was helpful and I love and you may have this on yourself as well better sex through mindfulness by Lori brotto

thank you so much for being at the Shell everybody who's listening if you want to get to know her and connect with her her phone number is 617-651-1436 definitely check out her website is pelvic Health support.com you can check on it for visits to her also check on it for resources you can email her at happy at pelvic Health support.com she's an Instagram pelvic floor in pee and voicing on LinkedIn and Kathie case of account thank you so much again for being on the show you're welcome back anytime thank you so much for having me dr. April I so appreciate it. You bring an intimacy back or follow us on YouTube Facebook iTunes or Spotify thank you